Complicated Anorectal case *Chief Complaints* 26 Years old male patient C/o severe pain & burning while defecating and hours after that. On proctoscope examination reveal swelling in anal canal ( piles ? ) and TRUS report attached which suggest the same. No h/o constipation as such. However, irregular lifestyle with no fix times for meals or excretory activities. Eating outside because travelling job. *History* Patient took below prescription from a general surgeon for 10 days Cap. RBSON D BD Tab. Oflox Oz BD Tab. Xymoheal D BD replaced by SignoFlam in later 5 days Anobliss ( Nifedipine + Lignocaine ) Cream for LA Syrup. Cremafinn Plus 15 ML at bed time Tab. Hilo ( Ayurvedic Preparation ) But no improvement. Urine retention also there. Was admitted with Foley's catheter for 4 days since 5 days following the same. *Investigations* Blood reports including infective etiology including HIV 1 &2, HBSAG, HSV, VDRL Negative. Apart from creat 1.2 ( possibly due to urine retention ) Urine RM findings negative. Please suggest the diagnosis and best line of treatment. *Management* EDIT - I got USG abdomen done to rule out high Creatinine. USG is normal. Moreover Urine CS shows E COLI growth 40,000 CFU/ml after 10 days of Oflox Oz and other symptomatic course. It showed sensitive to Amoxyclav so have started augmentin BD for the last few days and urine retention complaint has improved. But lately he has developed blood drops ( clotted & liquid form ) while defecating which aren't that painful. Is there any agressive which needs to be done?

39 years old male suffering from one week. *Chief Complaints* Burning sensation, tenderness, itching No any other complain. *History* Same problem arise before one year ago. *Vitals* BP - 120/80 mm/ hg. Puls - 84 bpm. SpO2 - 99% *Physical Examination* Acne type blisters, redness around the anus. Image attached below. *Investigations* Please suggest essential investigation?? *Diagnosis* What's the disease? *Management* Please suggest Treatment and management.

A35 yrs old male pt suffering such kind of lession on anal region... symptoms...mild bleeding and pain in during and after defecation of stool. purulent discharge itching c.constipation habits...hit desire of food and daily alcohol intake occupation.govt.bus driver all report s r normal...wbc only 12000 respected drs...plz Dx and Rx for dis case.

Dx, Rx Please, Pt. M, Age 37, Such a pile like reddish blister is formed Near To Anus, Pain nd itching, During nd After Defecation. How to Treat? Nd DX.

50 female known diabetic and hypertension. Present with pain and fever since 2 days. Lesion at rt side of anal region.